401k Plan data: SALARY CONVERSION/CAFETERIA PLAN plan

SALARY CONVERSION/CAFETERIA PLAN 401k Plan overview

Plan Name	SALARY CONVERSION/CAFETERIA PLAN
Plan identification number	512

SALARY CONVERSION/CAFETERIA PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental

401k Sponsoring company profile

CITIZENS MEDICAL CENTER has sponsored the creation of one or more 401k plans.

Company Name: CITIZENS MEDICAL CENTER

Employer identification number (EIN): 481112955

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SALARY CONVERSION/CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
512 2017-01-01 DARCY HOWARD DARCY HOWARD 2018-10-03
512 2016-01-01 DARCY HOWARD DARCY HOWARD 2017-10-10
512 2015-01-01 DARCY HOWARD DARCY HOWARD 2016-07-20
512 2014-01-01 GREG UNRUH GREG UNRUH 2015-07-15
512 2013-01-01 KEVAN TRENKLE KEVAN TRENKLE 2014-07-25
512 2012-01-01 KEVAN TRENKLE KEVAN TRENKLE 2013-06-28
512 2011-01-01 KEVAN TRENKLE KEVAN TRENKLE 2012-07-11
512 2010-01-01 KEVAN TRENKLE KEVAN TRENKLE 2011-07-14
512 2009-01-01 KEVAN TRENKLE KEVAN TRENKLE 2010-09-24

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
512	2017-01-01	DARCY HOWARD	DARCY HOWARD	2018-10-03
512	2016-01-01	DARCY HOWARD	DARCY HOWARD	2017-10-10
512	2015-01-01	DARCY HOWARD	DARCY HOWARD	2016-07-20
512	2014-01-01	GREG UNRUH	GREG UNRUH	2015-07-15
512	2013-01-01	KEVAN TRENKLE	KEVAN TRENKLE	2014-07-25
512	2012-01-01	KEVAN TRENKLE	KEVAN TRENKLE	2013-06-28
512	2011-01-01	KEVAN TRENKLE	KEVAN TRENKLE	2012-07-11
512	2010-01-01	KEVAN TRENKLE	KEVAN TRENKLE	2011-07-14
512	2009-01-01	KEVAN TRENKLE	KEVAN TRENKLE	2010-09-24

Plan Statistics for SALARY CONVERSION/CAFETERIA PLAN

401k plan membership statisitcs for SALARY CONVERSION/CAFETERIA PLAN

Measure Date Value
2017: SALARY CONVERSION/CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 361
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 315
Total of all active and inactive participants 2017-01-01 315
2016: SALARY CONVERSION/CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 279
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 321
Total of all active and inactive participants 2016-01-01 321
2015: SALARY CONVERSION/CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 224
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 246
Total of all active and inactive participants 2015-01-01 246
2014: SALARY CONVERSION/CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 265
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 224
Total of all active and inactive participants 2014-01-01 224
2013: SALARY CONVERSION/CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 252
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 265
Total of all active and inactive participants 2013-01-01 265
2012: SALARY CONVERSION/CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 243
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 252
Total of all active and inactive participants 2012-01-01 252
2011: SALARY CONVERSION/CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 177
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 243
Total of all active and inactive participants 2011-01-01 243
2010: SALARY CONVERSION/CAFETERIA PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 177
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 177
Total of all active and inactive participants 2010-01-01 177
2009: SALARY CONVERSION/CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 163
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 177
Total of all active and inactive participants 2009-01-01 177

Measure	Date	Value
2017: SALARY CONVERSION/CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	361
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	315
Total of all active and inactive participants	2017-01-01	315
2016: SALARY CONVERSION/CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	279
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	321
Total of all active and inactive participants	2016-01-01	321
2015: SALARY CONVERSION/CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	224
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	246
Total of all active and inactive participants	2015-01-01	246
2014: SALARY CONVERSION/CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	265
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	224
Total of all active and inactive participants	2014-01-01	224
2013: SALARY CONVERSION/CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	252
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	265
Total of all active and inactive participants	2013-01-01	265
2012: SALARY CONVERSION/CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	243
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	252
Total of all active and inactive participants	2012-01-01	252
2011: SALARY CONVERSION/CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	177
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	243
Total of all active and inactive participants	2011-01-01	243
2010: SALARY CONVERSION/CAFETERIA PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	177
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	177
Total of all active and inactive participants	2010-01-01	177
2009: SALARY CONVERSION/CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	163
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	177
Total of all active and inactive participants	2009-01-01	177

Form 5500 Responses for SALARY CONVERSION/CAFETERIA PLAN

2017: SALARY CONVERSION/CAFETERIA PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: SALARY CONVERSION/CAFETERIA PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: SALARY CONVERSION/CAFETERIA PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: SALARY CONVERSION/CAFETERIA PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: SALARY CONVERSION/CAFETERIA PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: SALARY CONVERSION/CAFETERIA PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: SALARY CONVERSION/CAFETERIA PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: SALARY CONVERSION/CAFETERIA PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: SALARY CONVERSION/CAFETERIA PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

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Company Name:	CITIZENS MEDICAL CENTER
Employer identification number (EIN):	481112955
NAIC Classification:	622000
NAIC Description:	Hospitals